Laryngopharyngeal reflux (LPR) patients with obstructive sleep apnea syndrome (OSAS) may have fewer hypopharyngeal reflux events (HRE) and less severe otolaryngological symptoms compared against those with LPR only. These findings were reported in Clinical Otolaryngology.

The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) identifies HRE and is currently the best way to diagnose LPR. Although many studies reported the coexistence of LPR and OSAS, the exact role of reflux in the pathogenesis of OSAS has not been fully elucidated.

A team of investigators conducted a prospective study to explore the profile of patients with OSAS and LPR at the HEMII-pH and to compare the reflux findings with LPR patients without OSAS.

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From August 2019 to June 2020, patients with LPR and OSAS were prospectively recruited from the Polyclinique Elsan (Poitiers, France) and CHU Saint-Pierre (Brussels, Belgium). Sleep disturbance was the primary reason for patient consultation. Patients with both sleep disturbance and LPR symptoms were included in the study.

All patients simultaneously underwent 24-hour HEMII-pH (Versaflex Z®, Digitrapper pH-Z testing System, Medtronic, Europe) and polysomnography (Cidelec LXe, Loire, France). An outcome comparison of reflux symptom score (RSS), gastrointestinal, and HEMII-pH was conducted between LPR patients and patients with LPR and OSAS. Multivariate analysis was used to investigate the relationship between reflux data and the following sleep outcomes: Apnea-Hypopnea Index, Epworth Sleepiness Scale (ESS) and paradoxical sleep data.

A total of 89 patients (45 LPR and 44 with OSAS and LPR) completed the study. Among LPR patients, the numbers of upright and daytime HREs and the otolaryngological RSSs were significantly higher compared against those with OSAS and LPR. A significant positive association was found between RSS quality of life score and ESS (P=.001).

The number of HREs in the evening was associated with higher ESS (P=.015). Compared against those without gastroesophageal reflux disease (GERD), patients with OSAS, LPR, and GERD had higher numbers of nocturnal HREs (P=.001).

This study was limited by its relatively small study population size and the lack of investigation into laryngopharyngeal signs.

These data indicated that the presence of OSAS in LPR patients may be associated with fewer HREs compared against those with LPR only, which may be clinically observed by less severe ear, nose, and throat symptoms. However, OSAS patient profiles may differ based on the occurrence of GERD.

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Bobin F, Auregan G, Muls V, et al. Impedance-pH monitoring profile of patients with reflux and obstructive sleep apnea syndrome: a controlled study. Clin Otolaryngol. Published online February 23, 2021. doi:10.1111/COA.13745